Internal Bank Loan Review Primary Officer: Prepared By: Date Prepared:

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1 Internal Bank Loan Review Primary Officer: Prepared By: Date Prepared: Loan Request Borrower: Business Information: Form: Organ Date: Type: Management: Ownership: Guarantors: Typically the owner of the business Request: Purpose: Terms: Type Amount Rate/Fees Term Repayment Source of Repayment Primary: Secondary Tertiary: Collateral Description: Collateral Valuation: Type Accounts Receivable Appraised Value % of ADV 75% (0-90 days) Inventory 30% Equipment 75% Marketable Securities 70% Commercial and Residential Property 75% Vacant Land 30-50% Debt Avail. Equity LTV

2 Flood Hazard: Environmental Concerns: Bow Debt: Type Open High Bal. # of REN Rate Terms SEC LTV Bow Payment History: Line of Credit Usage: Low Balance: # of Days at Zero: Other Debts: Depository Relationship: Name Acct # Type Opened Balance Avg. Col. Bal. Rate Average Cost of Funds: Trust Relationship: Background Information: Financial Statement: Last 3 years of business financial statements and/or tax returns Last 3 years of owner s personal tax return Current personal financial statement

3 BUSINESS LOAN APPLICATION Date: New Relationship Existing Relationship Branch: Officer: BUSINESS INFORMATION Business Name Telephone ( ) Tax I.D. Individual Name(s) Telephone ( ) Social Security # Date of Birth: Proprietorship Partnership Sub-Chapter S Corporation Non-Profit Individual LLC Ownership Distribution: (List stockholders, partners, owner names) Note: Attach separate sheet if additional space needed. Name Title # of Years % SS# Name Title # of Years % SS# Name Title # of Years % SS# Nature of Business Year Established Number of Employees Years at Present Location [ ] Own [ ] Lease Accountant Telephone ( ) Insurance Agent Telephone ( ) Attorney Telephone ( ) FINANCIAL INFORMATION Bank of Account Account Number Credit Relationships: Please provide details of your business credit relationships below: Original Loan Amount Maturity Name of Creditor Purpose of Loan Amount Presently Owing Repayment Terms Date $ $ $ $ $ $

4 LOAN REQUEST Amount of Loan Requested Type of loan Requested Term of Loan [ Specific Loan Purpose (Check all that apply) [ ] Line of Credit [ ] Term Loan ] Business Home Equity [ ] Commercial Real Estate [ ] Working Capital [ ] Other (State type of loan required and loan [ ] Finance Purchase of Inventory purpose) [ ] Finance Purchase of Equipment [ ] Finance Purchase of Real Estate [ ] Finance Purchase of Business [ ] Refinance Existing Loan or Debts Collateral Available* (Check all that apply) [ ] All Assets (accounts receivable, inventory, machinery and equipment) [ ] Specific Equipment (Please attach equipment list, including serial numbers or description of equipment, and invoices for new equipment.) [ ] Real Estate (Please attach property address, legal description and a copy of most recent tax bill.) Square Feet Acres [ ] Cash on Deposit at (name of bank) Branch Account # [ ] Personal Assets (As described in Personal Financial Statement.) * Collateral: Loans are secured by collateral, which is property in which a security interest is granted to secure repayment of the loan. The loan collateral may include business assets, stocks, bonds, certificates of deposits, or personal assets. Consider (1) the value of the loan collateral must be equal to or greater than the amount of the loan, (2) expected economic life of collateral will be considered by the Bank in evaluating the collateral offered for the loan, (3) formal collateral appraisals may be required, and (4) a pledge of personal assets may be required as additional collateral for the business loan requested. [ ] Guarantors** (Please list) Name Social Security # Name Social Security # Name Social Security # ** Guarantors: For incorporated borrowers, guarantees of owner(s) is usually required, unless secured by Bank deposits or marketable collateral. If personal assets are in joint names, a sole proprietorship, and/or partnership, the Bank may require all parties to pledge collateral.

5 BUSINESS BACKGROUND INFORMATION Please provide a brief history of your business, future plans and projections, and describe your products and/or services and competition. PERSONAL BUSINESS EXPERIENCE If you have been in your present business for under five years, please describe your previous business experience. (Include business background, management experience, and training, or include a resume.) MISCELLANEOUS INFORMATION Are tax liabilities current? [ ] Yes [ ] No Settled through Is the business an endorser, guarantor, or co-maker for any obligation not listed in the financial statements? [ ] Yes [ ] No If yes, what is the contingent liability? Has the business or principal owner ever declared bankruptcy? [ ] Yes [ ] No If yes, provide details on a separate sheet. Is the business a defendant in any lawsuit? [ ] Yes [ ] No If yes, provide details on a separate sheet. Are any of the business assets encumbered by liens or attachments of any type? [ ] Yes [ ] No What By whom Amount $ What By whom Amount $ What By whom Amount $ Does the business have a pension fund? [ ] Yes [ ] No profit-sharing plan? [ ] Yes [ ] No If so, does the plan have any unfunded pension liabilities? [ ] Yes [ ] No Amount $

6 CERTIFICATION The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying statements and documents is true, complete, and correct. The undersigned agrees to notify the Bank immediately of any material changes in this information. It is further agreed that, whether or not the loan herein applied for is approved, the undersigned will pay or reimburse the bank for the costs, if any, of surveys, title or mortgage examinations, appraisals, etc., performed by non-bank personnel with the consent of the applicant. The undersigned authorizes the Bank to contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dunn & Bradstreet reports or information from Experian Credit Data. Business Name (print): Applicant Signature: Applicant Title: Date: Guarantor(s) Signature: Guarantor(s) Signature: Date: Date: BUSINESS LOAN APPLICATION CHECKLIST Please be sure all of the following documentation has been included in order for your business loan application to be processed. [ ] Business Loan Application [ ] Accountant-Prepared Business Financial Statements (Profit and Loss, Balance Sheet) for the past three fiscal years [ ] Business Federal Tax Returns for past three fiscal years [ ] Interim Financial Statements (if available) [ ] Most Recent Federal Tax Returns for each principal owner listed in the first section of the Business Loan Application [ ] Personal Financial Statement [ ] Organizational Papers (Articles, dba papers, etc.) [ ] OTHER:

Name Title # of Years % SS# Name Title # of Years % SS# Name Title # of Years % SS#

Name Title # of Years % SS# Name Title # of Years % SS# Name Title # of Years % SS# BUSINESS LOAN APPLICATION New Relationship Existing Relationship Branch: Drop-down options Officer: BUSINESS INFORMATION Business Name Telephone ( ) Tax I.D. Individual Name(s) Telephone ( ) Social Security

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